|Publication number||US7214180 B2|
|Application number||US 10/338,163|
|Publication date||8 May 2007|
|Filing date||6 Jan 2003|
|Priority date||10 Aug 1999|
|Also published as||US7398781, US20060052660, US20060229490|
|Publication number||10338163, 338163, US 7214180 B2, US 7214180B2, US-B2-7214180, US7214180 B2, US7214180B2|
|Inventors||Albert K Chin|
|Original Assignee||Origin Medsystems, Inc.|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (106), Non-Patent Citations (39), Referenced by (16), Classifications (50), Legal Events (5)|
|External Links: USPTO, USPTO Assignment, Espacenet|
This application is a continuation of application Ser. No. 09/779,715, filed Feb. 8, 2001, by Albert K. Chin, entitled “Apparatus and Method for Cardiac Restraint”, now issued as U.S. Pat. No. 6,569,082, which application is a continuation in part of pending application Ser. No. 09/635,345, filed Aug. 9, 2000, by Albert K. Chin, entitled “Apparatus and Method for Subxiphoid Endoscopic Access”, which applications are incorporated herein in the entireties by this reference thereto which claims benefit of Ser. No. 60/148,130 filed Aug. 10, 1999, and claims benefit of Ser. No. 60/150,737 filed Aug. 25, 1999.
1. Field of the Invention
The present invention relates to apparatus and methods for restraining the heart. More particularly, the invention relates to apparatus and methods for accessing the pericardium and at least partially enclosing the heart with a cardiac restraint apparatus.
2. Description of the Related Art
The present invention is generally directed to apparatus and methods for restraint of the cardiac wall. The invention is particularly suited for the treatment of cardiac diseases which result in atrial or ventricular dilation. The invention includes minimally invasive methods to access the heart and restrain the cardiac wall, resulting in the prevention or reduction of cardiac dilation in patients known to have experienced such dilation or who have a predisposition for such dilation occurring in the future. A cardiac restraint apparatus according to the present invention is typically applied to the epicardial surface of the heart, such that the cardiac restraint apparatus at least partially enclosed the heart.
Cardiac dilation occurs with different forms of cardiac disease, including congestive heart disease, post-myocardial infarctions, and dilated cardiomyopathy. In certain instances, congestive heart disease may result from viral infections. In such cases, the heart may enlarge to such an extent that the adverse consequences of heart enlargement continue after the viral infection has passed and the disease continues its progressively debilitating course. In some cases, such as post-myocardial infarction, the dilation may be localized to only a portion of the heart. In other cases, such as hypertrophic cardiomyopathy, there is typically increased resistance to filling of the left ventricle with concomitant dilation of the left atria. In dilated cardiomyopathy, the dilation is typically of the left ventricle with resultant failure of the heart as a pump. In advanced cases, dilated cardiomyopathy involves the majority of the heart. Causes of congestive heart disease are not fully known.
As the heart enlarges, the heart is performing an increasing amount of work in order to pump blood during each heart beat. In time, the heart becomes so enlarged that the heart cannot adequately supply blood. An afflicted patient is fatigued, unable to perform even simple exerting tasks and experiences pain and discomfort. Further, as the heart enlarges, the internal heart valves cannot adequately close. This impairs the function of the valves and further reduces the heart's ability to supply blood. With each type of cardiac dilation, there are associated problems ranging from arrhythmias which arise due to the stretch of myocardial cells, to leakage of the cardiac valves due to enlargement of the valvular annulus.
Drugs are sometimes employed to assist in treating problems associated with cardiac dilation. For example, Digoxin increases the contractility of the cardiac muscle and thereby causes enhanced emptying of the dilated cardiac chambers. On the other hand, some drugs, for example, beta-blocking drugs, decrease the contractility of the heart and thus increase the likelihood of dilation. Other drugs including angiotensin-converting enzyme inhibitors such as Enalopril, which help to reduce the tendency of the heart to dilate under the increased diastolic pressure experienced when the contractility of the heart muscle decreases. Many of these drugs, however, have side effects which make them undesirable for long-term use.
Apparatus to prevent or reduce dilation and thereby reduce the consequences of dilation have also been described. Patches made from low porosity materials, for example Dacron™, have been used to support the cardiac wall. Other apparatus are found in U.S. Pat. No. 4,957,477 to Lundback dated Sep. 18, 1990; U.S. Pat. No. 5,131,905 to Grooters dated Jul. 21, 1992; U.S. Pat. No. 5,150,706 to Cox et al. dated Sep. 29, 1992; U.S. Pat. No. 5,143,082 to Kindberg et al dated Sep. 1, 1992; U.S. Pat. No. 5,256,132 to Snyders dated Oct. 26, 1993; U.S. Pat. No. 5,702,343 to Alferness dated Dec. 30, 1997; U.S. Pat. No. 6,077,218 to Alferness dated Jun. 20, 2000; U.S. Pat. No. 6,085,754 to Alferness dated Jul. 11, 2000; and U.S. Pat. No. 6,095,968 to Snyders dated Aug. 1, 2000.
The '477 patent teaches a double-walled jacket surrounding the heart. A fluid fills a chamber between the walls of the jacket. The inner wall is positioned against the heart and is pliable to move with the heart. Movement of the heart during beating displaces fluid within the jacket chamber. The '706 patent discloses a medical apparatus for enclosing an internal body organ, comprising a filamentary strand with noose and free end portions and a surgical bag with an opening. The '082 patent discloses a cooling net for cardiac or transplant surgery, comprising a porous net that is fitted and secured around the organ. Both of the '905 and '132 patents teach cardiac assist apparatus which pump fluid into chambers opposing the heart to assist systolic contractions of the heart. The '343 and '218 patents teach an adjustable jacket to constrain cardiac expansion during diastole. The '754 patent discloses a biologically compatible jacket adapted to be secured to the heart. The '968 patent discloses a viscous cardioplasty jacket for buttressing the ventricular heart walls.
None of these apparatus include a sheath to facilitate endoscopic introduction of the apparatus, or guide elements for positioning the cardiac restraint apparatus around the heart. Moreover, none of these apparatus include hollow guide tubes that permit an instrument to be advanced through their lumens to engage the mouth of the jacket and secure the mouth of the jacket to the pericardium. Furthermore, none of these references teach the introduction of a cardiac restraint apparatus via a single subxiphoid incision. Accordingly, there is a need for an improved cardiac restraint apparatus that can be more easily introduced via a minimally invasive approach, and improved minimally invasive methods for introducing cardiac restraint apparatus.
The invention is a method and apparatus for accessing the heart within the pericardium and restraining the heart by at least partially enclosing the heart with a cardiac restraint apparatus.
One embodiment of a cardiac restraint apparatus according to the invention comprises a jacket, the jacket having a rim which defines an opening for receiving a heart. The apparatus also comprises a knot pusher that has a hollow elongate body, and a strand that extends around the rim of the jacket and is tied into a slipknot. The strand is positioned such that at least one end portion of the strand extends through the knot pusher such that a distal end of the knot pusher can be moved into engagement with the slipknot, whereby pulling the end portion of the strand away from the heart while pushing the knot pusher against the slipknot and reducing the diameter of the opening defined by the rim. In addition, the apparatus comprises one or more guide elements that are attached to the jacket.
In another embodiment of a cardiac restraint apparatus according to the invention, the jacket is folded to reduce the profile of the apparatus. Optionally, the folded jacket is enclosed by a sheath. One embodiment of such a sheath includes a generally cylindrical body having a proximal end and a distal end, and also includes perforations along the sheath body such that the sheath can be removed from the apparatus by tearing the sheath body along the perforations. Optionally, a pull tab is attached to the proximal end of the sheath body. By pulling the pull tab away from the jacket, the surgeon can tear the sheath along the perforations and remove the torn sheath from the patient.
In one embodiment of a cardiac restraint apparatus according to the invention, the strand extending around the rim of the jacket is a suture strand, for example a nylon suture strand.
In a class of embodiments the guide elements are one or more guide tubes removably attached to the rim of the jacket. In some of these embodiments, the guide tubes are hollow. In some of the embodiments, at least one of the guide tubes defines a lumen dimensioned to receive a surgical instrument, for example a tacking instrument. In other embodiments, the guide elements are one or more handles, for example handles composed of suture strands, attached to the rim of the jacket.
In another class of embodiments, the apparatus comprises at least one elastic band having a first portion terminating at a first end and a second portion terminating at a second end, with the first portion and the second portion of the elastic band being joined together at a location between the first end and the second end. The apparatus also includes a sheath, which includes a generally cylindrical body having a proximal end and a distal end. The sheath body may also define perforations, preferably longitudinally positioned perforations, such that the sheath can be removed from the apparatus by tearing the body along the perforations. The sheath can also include a pull tab that is attached to the proximal end of the sheath body, for pulling the sheath away from the apparatus by pulling the pull tab away from the jacket.
In some such embodiments, the elastic band includes calibrated markings for calibrating the tension of the elastic band. In other embodiments, the first and second ends of the elastic band are configured to be engaged by a grasping instrument.
Another aspect of the invention is a method of enclosing the heart with any embodiment of the inventive cardiac restraint apparatus. In one embodiment, the invention is a method of at least partially enclosing a heart with a cardiac restraint apparatus that includes a jacket. The method comprises the steps of: a) making a surgical incision to provide an entry point for the cardiac restraint apparatus; b) introducing a cutting tool through the incision and using the cutting tool to make an opening in the pericardium through which the cardiac restraint apparatus can be advanced into engagement with the heart; c) advancing the cardiac restraint apparatus through the incision and the opening into engagement with the heart; and d) sweeping the jacket along the heart to at least partially enclose the heart in the jacket. The surgical incision can be a subxiphoid incision, a trans-xiphoid incision, a thorascopic incision or another incision.
An alternative embodiment of the inventive method includes the steps of: a) making a surgical incision to provide an entry point for an endoscopic cannula; b) inserting the endoscopic cannula into the surgical incision, wherein the endoscopic cannula has at least one access port; c) advancing the endoscopic cannula to the pericardium under endoscopic visualization; d) introducing a cutting tool into the access port of the endoscopic cannula; e) making an opening in the pericardium using the cutting tool, through which the cardiac restraint apparatus can be advanced into engagement with the heart; f) advancing the endoscopic cannula into the pericardium through the opening; g) advancing the cardiac restraint apparatus into at least one access port of the endoscopic cannula into engagement with the heart; h) sweeping the jacket along the heart to at least partially enclose the heart in the jacket.
Another embodiment of a method according to the invention uses the embodiment of the cardiac restraint apparatus that includes a jacket and one or more guide tubes. In this method, the step of enclosing the heart with the cardiac restraint apparatus includes the steps of: a) advancing a tacking instrument into at least one access port of the endoscopic cannula to access the pericardium; b) tacking the rim of the jacket to the posterior pericardium using the tacking instrument; and c) manipulating the guide tubes of the cardiac restraint instrument to sweep the jacket over the anterior aspect of the heart thereby at least partially enclosing the heart with the jacket. The jacket is then tightened around the heart by reducing the diameter of the opening of the jacket by pulling the end portion of the strand away from the heart while pushing the knot pusher against the slipknot.
Another embodiment of a method according to the invention uses the embodiment of the cardiac restraint apparatus that includes a jacket and one or more handles. In this method, the step of enclosing the heart with the cardiac restraint apparatus includes the steps of: a) advancing one or more guide strands into at least one access port of the endoscopic cannula, the one or more guide strands having a sufficient length to enable the proximal ends of the one or more guide strands to be grasped outside the body when the distal ends of the guide strands are positioned near the heart; b) advancing a tacking instrument into at least one access port of the endoscopic cannula; c) tacking the one or more guide strands to the posterior pericardium using the tacking instrument; d) passing the one or more guide strands through the one or more handles on the rim; and e) using the guide strands to manipulate the jacket, thereby at least partially enclosing the heart with the jacket.
Another embodiment of a method of restraining the heart with a cardiac restraint apparatus involves a cardiac restraint apparatus that includes an elastic band. The method comprises the steps of: a) making a surgical incision to provide an entry point for the cardiac restraint apparatus; b) introducing a cutting tool through the incision and using the cutting tool to make an opening in the pericardium through which the cardiac restraint apparatus can be advanced into engagement with the heart; c) advancing the cardiac restraint apparatus through the incision and the opening into engagement with the heart; and d) restraining the heart with the elastic band by securing the elastic band around the heart. This method includes methods in which the surgical incision is a subxiphoid incision, a trans-xiphoid incision, and a thorascopic incision.
An alternative embodiment of this method includes the steps of: a) making a surgical incision to provide an entry point for an endoscopic cannula; b) inserting the endoscopic cannula into the surgical incision, wherein the endoscopic cannula has at least one access port; c) advancing the endoscopic cannula to the pericardium under endoscopic visualization; d) introducing a cutting tool into the access port of the endoscopic cannula; e) making an opening in the pericardium using the cutting tool, through which the cardiac restraint apparatus can be advanced into engagement with the heart; f) advancing the endoscopic cannula into the pericardium through the opening; g) advancing the cardiac restraint apparatus into at least one access port of the endoscopic cannula into engagement with the heart; and h) restraining the heart with the elastic band by securing the elastic band around the heart.
In the methods using the cardiac restraint apparatus that includes at least one elastic band, in one embodiment the step of restraining the heart with the cardiac restraint apparatus can include the steps of: a) advancing a tacking instrument into the opening in the pericardium (or, in the minimally invasive methods, into the access port of the endoscopic cannula to access the pericardium); b) tacking the elastic band to the posterior pericardium at a point between the first end and the second end; c) grasping the first portion, moving the first portion to the anterior aspect of the heart, and tacking the first portion to the pericardium overlying the anterior aspect of the heart; d) grasping the second portion, moving the second portion over the anterior aspect of the heart, and tacking the second portion to the pericardium overlying the anterior aspect of the heart; and e) attaching (preferably by tacking or clipping) the first and second portions together (preferably at a location overlying the anterior aspect of the heart) to provide a calibrated tension on the heart. The steps of grasping the first and second portions of the elastic band may be performed with any of a variety of grasping tools, for example a clip applier.
As defined in this application, the word “distal” is used to describe that portion of the apparatus (or that direction of movement) which extends away from the user during use, and the word “proximal” is used to describe that portion of the apparatus (or that direction of movement) that extends toward the user during use.
Jacket 130 can be constructed of a wide variety of materials, but generally it should be constructed from materials that are biocompatible and non-toxic to bodily tissue, for example distensible or non-distensible mesh fabric constructed from silicon rubber, nylon, polyurethane, polyester, polytetrafluoroethylene (PTFE), expanded PTFE (ePTFE), polypropylene, stainless steel, and impregnated elastomers such as nylon in polyurethane or nylon in silicon rubber. While
Rim 140 is preferably hollow, for example constructed as a hollow tube or a folded fabric sleeve, which is capable of receiving and containing strand 160. Rim 140 may be constructed separately from any biocompatible, flexible material (such as biocompatible fabrics and plastics) and attached to jacket 130 around the perimeter of opening 150, or may alternatively be constructed by simply folding and securing the mesh fabric of jacket 140 around opening 150 to create a hollow fabric sleeve.
Knot pusher 120 can be constructed from any suitable material capable of being formed into a hollow tube, for example rigid and flexible plastics, metals such as stainless steel, and wood.
Strand 160 can be constructed from any conventional surgical suture material, for example nylon, silk, steel, catgut, and conventional bioabsorbable suture materials such as polymers and copolymers of lactide, glycotide, para-dioxanone and trimethylene carbonate. At least one end 165 of strand 160 is disposed within knot pusher 120. As used in the present invention, the term “strand” is deemed to include any of a variety of strings, fibers, wires, or sutures capable of being tied into a slipknot.
Referring again to
An alternative embodiment of a cardiac restraint apparatus according to the present invention is illustrated in
Handles 210 and 212 may be constructed from any conventional surgical suture material, for example nylon, silk, steel, catgut, and conventional bioabsorbable suture materials such as polymers and copolymers of lactide, glycotide, para-dioxanone and trimethylene carbonate. Handles 210 and 212 may be attached to rim 240 by any suitable means, for example using adhesives, welding, or tying handles 210 and 212 around rim 240. Optionally, handles 210 and 212 may be removably attached to rim 240, for example by using a perforated strap (not shown).
Sheath 320 can be constructed from any flexible material, including but not limited to polyethylene, polyvinylchloride, and teflon. Sheath 320 may be of any structure suitable to enclose jacket 130. Preferably, sheath 320 includes a generally cylindrical body 360 having a proximal end 315 and a distal end 318, sheath body 360 defining perforations 310 along sheath body 360, and pull tab 350 attached to proximal end 315. Preferably, perforations 310 are longitudinally positioned. Sheath body 360 defines a lumen having an inner diameter of preferably 7 mm to 10 mm. Sheath 320 is removable from apparatus 300 by tearing sheath body 360 along perforations 310. This removal is more easily accomplished by implanting sheath 320 with a pull tab 350 extending out from the proximal end 315 of sheath body 360. Pulling of pull tab 350 away from the apparatus 300 results in tearing of sheath body 360 along perforations 310 and removal of the torn sheath 320 from jacket 130.
Another alternative embodiment of a cardiac restraint apparatus according to the present invention is illustrated in
Each elastic band can be sheathed with a sheath, such as sheath 962 of
Optionally, the first and second ends of the elastic band 980 are configured to be engaged by a grasping instrument, for example by including openings 990 and 991 suitably sized to receive a grasping instrument.
Another aspect of the present invention is a class of methods of restraining the heart using any embodiment of the inventive cardiac restraint apparatus. While any suitable surgical approach to the heart may be used, for example trans-xiphoid or thorascopic incisions, the preferred incision is a subxiphoid incision large enough to allow for insertion of a cannula for performing minimally invasive surgery, preferably about 2 cm. An apparatus having a cannula through which the cardiac restraint apparatus of the present invention can be deployed, and methods of using the apparatus, are disclosed in detail in co-pending application Ser. No. 09/635,345, hereby incorporated by reference in its entirety.
Briefly, the surgical apparatus preferably used to deploy the cardiac restraint apparatus through a subxiphoid incision is an endoscopic cannula comprising a cannula, a transparent tip located at the distal end of the cannula, and an endoscope preferably positioned at the distal end of the cannula. The cannula has at least one lumen, and one or more additional lumens for advancement of surgical tools. The transparent tip is preferably tapered to provide better visualization by offsetting and retracting tissue away from the field of view. Still more preferably, the transparent tip has a generally conical shape. The transparent tip is preferably removable and replaceable, such that it may be removed when it is desired to obtain a sharper image of the surgical site.
In a preferred embodiment, the endoscopic cannula may comprise one or more access ports positioned at a proximal end of the cannula, for receiving surgical instruments into an instrument lumen of the cannula. Such a preferred endoscopic cannula further comprises an endoscopic eyepiece, skewed relative to the proximal end of the endoscope, for facilitating the viewing of a surgical site through the endoscope while minimizing interference with surgical instruments introduced into the cannula.
Using the methods of this invention, the endoscopic cannula is either directly advanced to the mediastinum or alternatively, a cavity is first dilated and the endoscopic cannula is advanced through the dilated cavity. Once the endoscopic cannula is advanced into the mediastinum, surgical tools are advanced through the one or more access ports, and surgical procedures are performed within the mediastinum. Surgical tools that are used with the endoscopic cannula in the methods of the present invention include a cutting tool for creating an opening in the pericardium, as well as the cardiac restraint apparatus of the present invention.
In directly advancing the endoscopic cannula, the endoscopic cannula is inserted directly into the initial subxiphoid incision and is guided, under endoscopic visualization, to the surgical site. Alternatively, a cavity toward the surgical site may be first dilated using a dilation tool according to this invention, and the cannula may be subsequently advanced within the dilated cavity. The second method is advantageous because as the dilation tool generally has a smaller diameter than the endoscopic cannula, initially inserting the dilation tool minimizes trauma to the heart and reduces the chance of ventricular fibrillation due to irritation of the heart with a large diameter instrument.
The dilation tool optionally used to dilate a cavity for the endoscopic cannula has an inner cannula having an elongated body, a transparent tip at the distal end of the elongated body, an endoscope, and an outer expandable sheath. Preferably, the dilation tool has a small maximal dimension which minimizes trauma to the pericardium upon reaching the pericardium. The inner cannula has a tip having an enlarged region positioned distal to a distal end of the outer expandable sheath. The inner cannula is withdrawn through the outer expandable sheath, and the expandable sheath dilates a cavity concurrent to the retraction of the tip. The expandable sheath exerts a radial force against the surrounding tissue as the tip is retracted through the sheath. The radial force provides a less traumatic dilation than conventional dilation techniques such as using a bougie dilation, in which shear force is directly applied to surrounding tissue.
Once the cavity is dilated, the endoscopic cannula is then inserted into the incision and advanced into the proximal end of the expandable sheath. As the endoscopic cannula is advanced to the pericardium through the sheath, it will also cause the expandable sheath to expand further and dilate the working tunnel to a sufficient size to accommodate the endoscopic cannula. The expandable sheath provides the additional benefit of guiding the endoscopic cannula to the proper position at the pericardium. Alternatively, the endoscopic cannula is inserted directly into the initial incision without dilation.
In order to restrain the heart with a cardiac restraint apparatus of the present invention using the subxiphoid method, the endoscopic cannula is advanced under endoscopic visualization, as described previously, either directly into the initial subxiphoid incision or after first dilating a cavity using a dilation tool as described herein. Upon reaching the pericardium, a flap of the pericardium is gripped using a pericardial entry instrument as described herein, and the flap is cut using a cutting tool to create an opening in the pericardium. In cutting the pericardium, this invention contemplates cutting the flap of the pericardium away from the underlying heart.
The subxiphoid approach method is particularly advantageous as it enables the surgeon to access all regions of the heart, that is a 360 degree access capability including the anterior, posterior, left and right regions of the heart. Using one embodiment of this method, the cannula is initially inserted into the pericardium via an incision near the apex of the heart and then swept over the anterior and posterior surfaces of the heart. It should be noted that while entry near the apex of the heart aids the surgeon by providing a landmark for easier recognition of the position of the endoscopic cannula within the body, such an entry is not required by this invention and other entry positions, such as entry in the posterior region of the heart, are also contemplated. Once inside the pericardium, the cannula can be maneuvered around the heart substantially because of the subxiphoid entry and the flexibility of soft tissue around the heart. Thus, all regions of the heart may be accessed without the need for invasively lifting or rotating the heart to access posterior or lateral vessels and structures.
The subxiphoid access method is advantageous over conventional methods. As this procedure is performed under endoscopic visualization it is minimally invasive. In addition, as the approach is through a subxiphoid incision, there is no need to go through the pleural cavity and thus no need to deflate the lungs. Also, although the method requires only a single incision (that is, the subxiphoid incision), using this method access is gained to all regions of the heart. Conventionally, such extensive access to the heart has only been possible using invasive methods such as pericardial window, open heart surgery, or port access surgery using several incisions and ports. Thus, using the subxiphoid access method as herein described, the surgeon may access all regions of the heart with a single incision, without needing to go through the pleural cavity.
The endoscopic cannula with the transparent tapered tip is used to bluntly dissect a path to the pericardium, through the fat and connective tissue. Direct visualization allows verification that the pericardial surface is clean and devoid of adherent fat. Application of the pericardial entry instrument may occur under visual guidance on an exposed pericardial surface.
The subxiphoid method for accessing the heart is illustrated in more detail in
With expandable sheath 920 in place, large diameter instruments can be sequentially inserted through the proximal end of expandable sheath 920 without exerting shear force on the tissue cavity. Expandable sheath 920 accommodates instruments of varying diameters and cross-sections. Thus, leaving expandable sheath 920 in place maintains a dilated cavity to the desired surgical site, facilitating the advancement of the next instrument to be used in the procedure to the correct position within the body.
Referring now to
It should be noted that while the above method of accessing the pericardium was described with reference to usage of a dilation tool having an expandable sheath, a dilation tool without an expandable sheath may also be used. In that embodiment, the inner cannula of the dilation tool can be used by itself to dilate a cavity to access the pericardium, and the endoscopic cannula can be inserted into the dilated cavity.
Once the heart is accessed, a cardiac restraint apparatus according to the invention may be introduced and positioned around the heart.
Next, sheath 320 is removed by pulling pull tab 350 away from the heart, tearing sheath 320 at perforations 310. The removal of sheath 320 frees jacket 130, causing it to unwind from its folded state. The tacking instrument 700 is then used to tack or staple rim 140 to the posterior pericardium near the base of the heart, using guide tubes 110 and 112 to better guide the placement of rim 140 and to hold rim 140 in place in the desired position during tacking. Following placement of tack 702, each guide tube 110 and 112 is detached from rim 140, for example by cutting strand 710 or unraveling knot 720 as illustrated in
As shown in
Alternatively, the endoscopic cannula may be advanced to the posterior pericardial space without deployment of the cardiac restraint apparatus, as shown in
Next, tacking instrument 700 is introduced into access port 909 (or alternatively, into a second access port, not shown) as illustrated in
Another alternative embodiment of the method uses an alternative embodiment of a cardiac restraint apparatus according to this invention, described above and illustrated in
Next, referring to
Next, as shown in
While this method has been described with reference to a subxiphoid approach using an endoscopic cannula, the invention also contemplates methods in which the surgical incision is a subxiphoid incision, a trans-xiphoid incision, and a thorascopic incision, with or without the usage of an endoscopic cannula. In addition, the invention contemplates the use of one or more elastic bands of varying widths, preferably using three elastic bands each having a width of 1 cm.
Although the invention has been described in connection with specific preferred embodiments, various modifications and variations of the described methods and compositions of the invention will be apparent to those skilled in the art without departing from the scope and spirit of the invention.
|Cited Patent||Filing date||Publication date||Applicant||Title|
|US207932||4 Oct 1876||10 Sep 1878||Improvement in surgical dilators|
|US702789||20 Mar 1902||17 Jun 1902||Charles Gordon Gibson||Dilator.|
|US1727495||8 Dec 1926||10 Sep 1929||Beinhold h|
|US1867624||1 Apr 1930||19 Jul 1932||Memorial Hospital For The Trea||Device for obtaining biopsy specimens|
|US2011169||13 Apr 1932||13 Aug 1935||Wappler Frederick Charles||Forcipated surgical electrode|
|US2028635||11 Sep 1933||21 Jan 1936||Wappler Frederick Charles||Forcipated surgical instrument|
|US2316297||15 Jan 1943||13 Apr 1943||Southerland Beverly A||Surgical instrument|
|US2868206||25 Jul 1956||13 Jan 1959||Stoesser Frederick G||Intra luminal vein stripper|
|US2944552||29 Dec 1958||12 Jul 1960||Richard B Wilk||Surgical instrument|
|US3185155||13 Mar 1963||25 May 1965||Slaten||Vein stripper|
|US3336916||30 Oct 1963||22 Aug 1967||Edlich Richard F||Electrocautery process|
|US3357433||3 Dec 1963||12 Dec 1967||Centre Nat Rech Scient||Endoscope for illumination and observation of contacting distal regions|
|US3856016||3 Nov 1972||24 Dec 1974||H Davis||Method for mechanically applying an occlusion clip to an anatomical tubular structure|
|US3870048||30 Jul 1973||11 Mar 1975||Yoon In Bae||Device for sterilizing the human female or male by ligation|
|US3882854||23 Aug 1973||13 May 1975||Research Corp||Surgical clip and applicator|
|US3920024||16 Apr 1973||18 Nov 1975||Vitatron Medical Bv||Threshold tracking system and method for stimulating a physiological system|
|US3934115||25 Sep 1973||20 Jan 1976||Peterson Gerald H||Method and apparatus for electric singe cutting|
|US4022191||4 Jun 1976||10 May 1977||Khosrow Jamshidi||Biopsy needle guard and guide|
|US4181123||28 Dec 1977||1 Jan 1980||The University Of Virginia Alumni Patents Foundation||Apparatus for cardiac surgery and treatment of cardiovascular disease|
|US4235246||5 Feb 1979||25 Nov 1980||Arco Medical Products Company||Epicardial heart lead and assembly and method for optimal fixation of same for cardiac pacing|
|US4270549||30 Apr 1979||2 Jun 1981||Mieczyslaw Mirowski||Method for implanting cardiac electrodes|
|US4271839||25 Jul 1979||9 Jun 1981||Thomas J. Fogarty||Dilation catheter method and apparatus|
|US4291707||30 Apr 1979||29 Sep 1981||Mieczyslaw Mirowski||Implantable cardiac defibrillating electrode|
|US4318410||7 Aug 1980||9 Mar 1982||Thomas J. Fogarty||Double lumen dilatation catheter|
|US4319562||27 Jul 1979||16 Mar 1982||The University Of Virginia Alumni Patents Foundation||Method and apparatus for permanent epicardial pacing or drainage of pericardial fluid and pericardial biopsy|
|US4479497||12 Nov 1982||30 Oct 1984||Thomas J. Fogarty||Double lumen dilatation catheter|
|US4493711||25 Jun 1982||15 Jan 1985||Thomas J. Fogarty||Tubular extrusion catheter|
|US4526175||22 Feb 1983||2 Jul 1985||Thomas J. Fogarty||Double lumen dilatation catheter|
|US4630609||14 May 1981||23 Dec 1986||Thomas J. Fogarty||Dilatation catheter method and apparatus|
|US4662371||10 Jun 1985||5 May 1987||Whipple Terry L||Surgical instrument|
|US4765341||25 Aug 1983||23 Aug 1988||Mieczyslaw Mirowski||Cardiac electrode with attachment fin|
|US4779611||24 Feb 1987||25 Oct 1988||Grooters Ronald K||Disposable surgical scope guide|
|US4784133||28 Jan 1987||15 Nov 1988||Mackin Robert A||Working well balloon angioscope and method|
|US4863440||23 Dec 1985||5 Sep 1989||Thomas J. Fogarty||Pressurized manual advancement dilatation catheter|
|US4921483||23 Sep 1987||1 May 1990||Leocor, Inc.||Angioplasty catheter|
|US4957477||9 May 1989||18 Sep 1990||Astra Tech Ab||Heart assist jacket and method of using it|
|US4991578||4 Apr 1989||12 Feb 1991||Siemens-Pacesetter, Inc.||Method and system for implanting self-anchoring epicardial defibrillation electrodes|
|US5033477 *||8 Sep 1989||23 Jul 1991||Thomas J. Fogarty||Method and apparatus for providing intrapericardial access and inserting intrapericardial electrodes|
|US5071428||15 Feb 1991||10 Dec 1991||Ventritex, Inc.||Method and apparatus for providing intrapericardial access and inserting intrapericardial electrodes|
|US5129394||7 Jan 1991||14 Jul 1992||Medtronic, Inc.||Method and apparatus for controlling heart rate in proportion to left ventricular pressure|
|US5131905||16 Jul 1990||21 Jul 1992||Grooters Ronald K||External cardiac assist device|
|US5143082||3 Apr 1991||1 Sep 1992||Ethicon, Inc.||Surgical device for enclosing an internal organ|
|US5150706||15 Aug 1991||29 Sep 1992||Cox James L||Cooling net for cardiac or transplant surgery|
|US5163949||17 Jul 1991||17 Nov 1992||Bonutti Peter M||Fluid operated retractors|
|US5183464||17 May 1991||2 Feb 1993||Interventional Thermodynamics, Inc.||Radially expandable dilator|
|US5215521||26 Nov 1991||1 Jun 1993||Cochran James C||Laparoscopy organ retrieval apparatus and procedure|
|US5246014||8 Nov 1991||21 Sep 1993||Medtronic, Inc.||Implantable lead system|
|US5256132||17 Aug 1992||26 Oct 1993||Snyders Robert V||Cardiac assist envelope for endoscopic application|
|US5271380||23 Oct 1991||21 Dec 1993||Siegfried Riek||Penetration instrument|
|US5318589||15 Apr 1992||7 Jun 1994||Microsurge, Inc.||Surgical instrument for endoscopic surgery|
|US5331975||2 Mar 1990||26 Jul 1994||Bonutti Peter M||Fluid operated retractors|
|US5334150||17 Nov 1992||2 Aug 1994||Kaali Steven G||Visually directed trocar for laparoscopic surgical procedures and method of using same|
|US5336252||22 Jun 1992||9 Aug 1994||Cohen Donald M||System and method for implanting cardiac electrical leads|
|US5339801||12 Mar 1992||23 Aug 1994||Uresil Corporation||Surgical retractor and surgical method|
|US5373840||2 Oct 1992||20 Dec 1994||Knighton; David R.||Endoscope and method for vein removal|
|US5376076||17 Nov 1993||27 Dec 1994||Kaali; Steven G.||Visually directed trocar for laparoscopic surgical procedures and method of using same|
|US5385156||27 Aug 1993||31 Jan 1995||Rose Health Care Systems||Diagnostic and treatment method for cardiac rupture and apparatus for performing the same|
|US5391156||6 Jan 1994||21 Feb 1995||Ethicon, Inc.||Flexible encoscopic surgical port|
|US5433198||11 Mar 1993||18 Jul 1995||Desai; Jawahar M.||Apparatus and method for cardiac ablation|
|US5437680||6 Jan 1993||1 Aug 1995||Yoon; Inbae||Suturing method, apparatus and system for use in endoscopic procedures|
|US5464447||28 Jan 1994||7 Nov 1995||Sony Corporation||Implantable defibrillator electrodes|
|US5482925||17 Mar 1994||9 Jan 1996||Comedicus Incorporated||Complexes of nitric oxide with cardiovascular amines as dual acting cardiovascular agents|
|US5496345||17 Oct 1994||5 Mar 1996||General Surgical Innovations, Inc.||Expansible tunneling apparatus for creating an anatomic working space|
|US5514153||14 Feb 1994||7 May 1996||General Surgical Innovations, Inc.||Method of dissecting tissue layers|
|US5540711||10 Mar 1995||30 Jul 1996||General Surgical Innovations, Inc.||Apparatus and method for developing an anatomic space for laparoscopic procedures with laparoscopic visualization|
|US5551947||17 Nov 1993||3 Sep 1996||Worldwide Optical Trocar Licensing Corporation||Visually directed trocar for laparoscopic surgical procedures and method of using same|
|US5569183||1 Jun 1994||29 Oct 1996||Archimedes Surgical, Inc.||Method for performing surgery around a viewing space in the interior of the body|
|US5569291||1 Feb 1995||29 Oct 1996||Ethicon Endo-Surgery, Inc.||Surgical penetration and dissection instrument|
|US5569292||1 Feb 1995||29 Oct 1996||Ethicon Endo-Surgery, Inc.||Surgical penetration instrument with transparent blades and tip cover|
|US5571161||12 Apr 1995||5 Nov 1996||Starksen; Niel F.||Apparatus and method for implanting electrical leads in the heart|
|US5591192||1 Feb 1995||7 Jan 1997||Ethicon Endo-Surgery, Inc.||Surgical penetration instrument including an imaging element|
|US5601576||10 Aug 1994||11 Feb 1997||Heartport Inc.||Surgical knot pusher and method of use|
|US5601589||29 Jun 1994||11 Feb 1997||General Surgical Innovations, Inc.||Extraluminal balloon dissection apparatus and method|
|US5607441||24 Mar 1995||4 Mar 1997||Ethicon Endo-Surgery, Inc.||Surgical dissector|
|US5613937||23 Aug 1994||25 Mar 1997||Heartport, Inc.||Method of retracting heart tissue in closed-chest heart surgery using endo-scopic retraction|
|US5613947||15 Nov 1995||25 Mar 1997||Origin Medsystems, Inc.||Everting cannula apparatus and method|
|US5618287||17 Mar 1995||8 Apr 1997||Thomas J. Fogarty||Methods of surgically implanting a defibrillator electrode within a patient|
|US5634895||7 Jun 1995||3 Jun 1997||Cormedics Corp.||Apparatus and method for transpericardial delivery of fluid|
|US5650447||17 Mar 1994||22 Jul 1997||The United States Of America As Represented By The Secretary Of The Department Of Health And Human Services||Nitric oxide-releasing polymers to treat restenosis and related disorders|
|US5653722||3 Jan 1995||5 Aug 1997||Kieturakis; Maciej J.||Anterograde/retrograde spiral dissector and method of use in vein grafting|
|US5653726||13 May 1996||5 Aug 1997||Archimedes Surgical, Inc.||Retrograde dissector and method for facilitating a TRAM flap|
|US5667520||29 Aug 1994||16 Sep 1997||General Surgical Innovations, Inc.||Method of performing balloon dissection|
|US5669927||24 Oct 1995||23 Sep 1997||Richard Wolf Gmbh||Instrument for morcellating|
|US5681278||23 Jun 1994||28 Oct 1997||Cormedics Corp.||Coronary vasculature treatment method|
|US5685820||26 Jan 1994||11 Nov 1997||Partomed Medizintechnik Gmbh||Instrument for the penetration of body tissue|
|US5690648||22 Mar 1996||25 Nov 1997||Thomas J. Fogarty||Methods and apparatus for rolling a defibrillator electrode|
|US5695504||24 Feb 1995||9 Dec 1997||Heartport, Inc.||Devices and methods for performing a vascular anastomosis|
|US5702343||2 Oct 1996||30 Dec 1997||Acorn Medical, Inc.||Cardiac reinforcement device|
|US5702417||22 May 1995||30 Dec 1997||General Surgical Innovations, Inc.||Balloon loaded dissecting instruments|
|US5707390||5 Jun 1995||13 Jan 1998||General Surgical Innovations, Inc.||Arthroscopic retractors|
|US5713950||2 Jun 1995||3 Feb 1998||Cox; James L.||Method of replacing heart valves using flexible tubes|
|US5716392||5 Jan 1996||10 Feb 1998||Medtronic, Inc.||Minimally invasive medical electrical lead|
|US5722977||24 Jan 1996||3 Mar 1998||Danek Medical, Inc.||Method and means for anterior lumbar exact cut with quadrilateral osteotome and precision guide/spacer|
|US5725492||4 Mar 1996||10 Mar 1998||Cormedics Corp||Extracorporeal circulation apparatus and method|
|US5728148||8 Nov 1996||17 Mar 1998||Pacesetter Ab||Stylet unit for implanting a medical electrode cable|
|US5730756||13 Feb 1995||24 Mar 1998||General Surgical Innovations, Inc.||Method for developing an anatomic space for laparoscopic procedures with laparoscopic visualization|
|US5738628||24 Mar 1995||14 Apr 1998||Ethicon Endo-Surgery, Inc.||Surgical dissector and method for its use|
|US5755764||10 Sep 1996||26 May 1998||Sulzer Intermedics Inc.||Implantable cardiac stimulation catheter|
|US5755765||24 Jan 1997||26 May 1998||Cardiac Pacemakers, Inc.||Pacing lead having detachable positioning member|
|US6010531 *||31 Jan 1996||4 Jan 2000||Heartport, Inc.||Less-invasive devices and methods for cardiac valve surgery|
|US6126590 *||23 Sep 1997||3 Oct 2000||Acorn Cardiovascular, Inc.||Cardiac reinforcement device|
|US6463332 *||14 Sep 2000||8 Oct 2002||Core Medical, Inc.||Method and system for pericardial enhancement|
|US6612978 *||10 Sep 2001||2 Sep 2003||Paracor Surgical, Inc.||Expandable cardiac harness for treating congestive heart failure|
|US6689048 *||23 Aug 2002||10 Feb 2004||Acorn Cardiovascular, Inc.||Delivery of cardiac constraint jacket|
|US6702732 *||8 Aug 2000||9 Mar 2004||Paracor Surgical, Inc.||Expandable cardiac harness for treating congestive heart failure|
|USRE29088||28 Oct 1975||28 Dec 1976||Surgical cutting instrument having electrically heated cutting edge|
|1||"Incision Decision", Atrium Medical Corporation advertisement, appearing in J. Thorac. Cardiovasc. Surg., 83(4). 1982.|
|2||"Saphenous Vein Grafts Are No. 1. Period" , Atrium Medical Corporation advertisement, appearing in J. Thorac. Cardiovas. Surg., 82(6), 1981.|
|3||Benetti, Federico, et al., "Video Assisted Coronary Bypass Surgery", J Card Surgery, 1995, pp. 620-625.|
|4||Broadman, R. et al., "ICD Implantation via Thoracoscopy, "Mailslot" Thoracotomy, and Subxiphoid Incision," The Annals of Thoracic Surgery, vol. 57, No. 2, Feb. 1994, pp. 475-476.|
|5||Carpentier, A., "Technique d'implantation de pace-maker par une voie d'abord abdominale sous-xyphoidienne," La Presse Medicale, Masson et Cie, Editeurs, Paris, vol. 76, No. 2, Jan. 13, 1968, 2 pp.|
|6||Comedicus Gets Approval to Sell Product in European Union, Mar. 1, 1999, Swenson NHB Investor Relations.|
|7||Comedicus Incorporated, Equity Investment Information Sheet, May 17, 1999.|
|8||Comedicus Incorporated, Update-Oct. 1999; Equity Investment Information Sheet, May 17, 1999.|
|9||De Feyter, P.J. et al., "Permanent Cardiac Pacing with Sutureless Myocardial Electrodes: Experience in First One Hundred Patients," PACE, vol. 3, No. 2, Mar. 1980, pp. 144-149.|
|10||Delaria, G.A. et al., "Leg Wound Complications Associated With Coronary Revascularization", J. Thorac, Cardiovasc. Surgery, 81:403-407, 1981.|
|11||Dimitri, W.R., et al., "A Quick and Atraumatic Method of Autologous Vein Harvesting Using the Subcutaneous Extraluminal Dissector", J. Cardiovasc. Surg., 28:103-11, 1987.|
|12||Fogarty, M.D., Thomas J., et al., "Selected Applications of Balloon Dissection", pp. 45-52.|
|13||Fontenelle, Larry, J., "Subxiphoid Pericardial Window", Thoracic and Cardiovascular Surgery, The American Association for Thoracic Surgery, Jul. 1971, vol. 62, No. 1, pp. 95-97.|
|14||Grandjean, Jan G., et al., "Coronary Reoperation via Small Laparotomy Using Right Gastroepiploic Artery Without CPB", Society of Thoracic Surgeons, 1996, pp.|
|15||Hauer, G., et al. "Endoscopic Subfascial Discussion of Perforating Vein", Surg. Endos. 2:5-12. 1988.|
|16||International Search Report and Written Opinion, PCT/US04/00760, Jul. 6, 2005.|
|17||International Search Report and Written Opinion, PCT/US04/00859, Jun 20, 2005.|
|18||International Search Report and Written Opinion, PCT/US04/00859, Jun. 20, 2005.|
|19||Kaminski, Diane, "Firm Aims to Bypass Heart-piercing Treatments", Medical Industry Today, Medical Data International, Sep. 23, 1998.|
|20||Kirklin, John W., et al., "Cardiac Surgery: Morphology, Diagnostic Criteria, Natural History, Techniques, Results, and Indications", vol. 2, Second Edition, 1993, Chapter 52, p. 1695.|
|21||Levin, Bradley H., "The Subxiphoid Pericardial Window", Surgery, Gynecology & Obstetrics, Dec. 1982, vol. 155, pp. 804-806.|
|22||Meldrum-Hanna, W. et al., "Long Saphenous Vein Harvesting," J. Surg., 56:923-924, 1986.|
|23||Moazami, N., M.D. et al., "Minimatly Invasive Greater Saphenous Vein Harvesting For Coronary Artery Bypass Surgery", Mar. 1997, pp. 94-98.|
|24||Myers, E. L. et al., "Tsg101, an Inactive Homologue of Ubiquitin Ligase E2, Interacts Specifically With Human Immunodeficiency Virus Type 2 Gag Polyprotein and Results in Increased Levels of Ubiquianted Gag," J. Virol, Nov. 2002, vol. 76, No. 22.|
|25||PCT International Search Report and Written Opinion, PCT/US04/00760, Sep. 27, 2006, 7 pages.|
|26||PCT International Search Report and Written Opinion; PCT/US04/34538, Nov. 3, 2005, 10 pages.|
|27||Prager, Richard L., et al., "The Subxiphoid Approach to Pericardial Disease", The Annals of Thoracic Surgery, vol. 34, No. 1, Jul. 1982.|
|28||Rashid, A., et al., "Subcutaneous Technique for Saphenous Vein Harvest", Ann. Thorac. Surg., 37(2):169-170. 1984.|
|29||S. Bartoccioni, et al., Laparoscopic Harvesting of Right Gastroepiploic Artery for Coronary Artery Bypass Graft Performed Without Sternotomy [online], [retrieved on Oct. 5, 1999] Retrieved from the internet <URL:http://www.ctsnet.org/doc/2628.|
|30||Sabiston, David C., Jr., et al., "Atlas of Cardiothoracic Surgery", W.B. Saunders Company, 1995, pp. 235-237.|
|31||Santos, Gil H., et al., "The Subxiphoid Approach in the Treatment of Pericardial Effusion", Albert Einstein College of Medicine, Sep. 21, 1976, pp.467-470.|
|32||Simonsen, Michael, Ph.D., "Researchers Undaunted by Setbacks in the Angiogenesis Sector", American Health Consultants, vol. 5, No. 5, May 1999.|
|33||Spodick, David H., "Directly Applied Cardiac Therapy: Experts Explore Potential Benefits", Internal Medicine World Report, 1998.|
|34||Spodick, David H., "IPTD: Intrapericardial Therapeutics and Diagnostics: The PerDUCER Permits Direct Access to the Heart", Cath-Lab Digest, Sep. 1999, vol. 7, No. 9.|
|35||Stewart, S., M.D., "Placement of the Sutureless Epicardial Pacemaker Lead by the Subxiphoid Approach," The Annals of Thoracic Surgery, vol. 18, No. 3, Sep. 1974, pp. 308-313.|
|36||The 4<SUP>th </SUP>International Symposium on Intrapericardial Therapeutics and Diagnostics, Mar. 6, 1999, New Orleans, Louisiana.|
|37||Watkins, Jr., L., M.D. et al., "Implantation of the Automatic Defibrillator: The Subxiphold Approach," The Annals of Thoracic Surgery, vol. 34, No. 5, Nov. 1982, pp. 515-520.|
|38||Wheatley, D.J., M.D., ed., "Surgery of Coronary Artery Disease", C.V. Mosby Company, pp. 348-349, pp. 374-375.|
|39||Zentati M., M.D. et al., "Left Heart Pacing Lead Implantation Using Subxiphoid Videopericardloscopy," J. Cardiovasc Electrophysiol, vol. 14, Sep. 2003, pp. 949-963.|
|Citing Patent||Filing date||Publication date||Applicant||Title|
|US7867163||12 Dec 2008||11 Jan 2011||Maquet Cardiovascular Llc||Instrument and method for remotely manipulating a tissue structure|
|US7938842||10 May 2011||Maquet Cardiovascular Llc||Tissue dissector apparatus|
|US7972265||21 Jul 2004||5 Jul 2011||Maquet Cardiovascular, Llc||Device and method for remote vessel ligation|
|US7981133||21 Dec 2007||19 Jul 2011||Maquet Cardiovascular, Llc||Tissue dissection method|
|US8241210||4 Jan 2008||14 Aug 2012||Maquet Cardiovascular Llc||Vessel retractor|
|US8282565||12 Mar 2008||9 Oct 2012||University Of Virginia Patent Foundation||Access needle pressure sensor device and method of use|
|US8460331||22 Apr 2011||11 Jun 2013||Maquet Cardiovascular, Llc||Tissue dissector apparatus and method|
|US8961551||22 Dec 2006||24 Feb 2015||The Spectranetics Corporation||Retractable separating systems and methods|
|US8986335||10 Jun 2013||24 Mar 2015||Maquet Cardiovascular Llc||Tissue dissector apparatus and method|
|US9005109||15 Apr 2011||14 Apr 2015||Mardil, Inc.||Cardiac disease treatment and device|
|US9028520||22 Dec 2006||12 May 2015||The Spectranetics Corporation||Tissue separating systems and methods|
|US9144431||30 Sep 2010||29 Sep 2015||Aegis Medical Innovations Inc.||Enhanced signal navigation and capture systems and methods|
|US20040260144 *||27 Oct 2003||23 Dec 2004||The Foundry, Inc.||Ventricular infarct assist device and methods for using it|
|US20060009831 *||29 Jul 2005||12 Jan 2006||Lilip Lau||Cardiac harness having leadless electrodes for pacing and sensing therapy|
|US20060189840 *||18 Feb 2005||24 Aug 2006||Acorn Cardiovascular, Inc.||Transmyocardial delivery of cardiac wall tension relief|
|US20120172662 *||16 Dec 2011||5 Jul 2012||Boston Scientific Scimed, Inc.||Snare with Retractable Engaging Members|
|International Classification||A61B17/00, A61B17/32, A61B18/00, A61B17/34, A61B17/30, A61B17/22, A61B19/00, A61N1/05, A61B1/01, A61B18/14, A61B17/06, A61F13/00|
|Cooperative Classification||A61B17/3468, A61B17/3417, A61B2018/00392, A61B18/1482, A61B17/06109, A61B17/3403, A61B2017/00243, A61B19/54, A61B17/320068, A61N2001/0578, A61B1/00154, A61B17/00008, A61B2017/061, A61F2002/2484, A61B2018/00982, A61B2017/00247, A61B2018/00291, A61B2017/3488, A61B17/3421, A61B2017/22077, A61B2019/306, A61B19/201, A61B2017/3445, A61B2017/320044, A61B17/3478, A61F2/2481, A61B2017/306, A61B2019/462, A61N1/0587|
|European Classification||A61B17/00B, A61B17/34G, A61B17/34D, A61B17/34G4, A61N1/05P, A61B17/06N12, A61F2/24W2, A61B19/20B|
|7 Aug 2007||CC||Certificate of correction|
|5 Feb 2008||AS||Assignment|
Owner name: MAQUET CARDIOVASCULAR LLC,CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:BOSTON SCIENTIFIC LIMITED;BOSTON SCIENTIFIC SCIMED, INC.;CORVITA CORPORATION;AND OTHERS;REEL/FRAME:020462/0322
Effective date: 20080102
|13 Dec 2010||REMI||Maintenance fee reminder mailed|
|8 May 2011||LAPS||Lapse for failure to pay maintenance fees|
|28 Jun 2011||FP||Expired due to failure to pay maintenance fee|
Effective date: 20110508